Provider Demographics
NPI:1750959508
Name:COLLIN COUNTY MENTAL HEALTH MENTAL RETARDATION CENTER
Entity type:Organization
Organization Name:COLLIN COUNTY MENTAL HEALTH MENTAL RETARDATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTS
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-562-0190
Mailing Address - Street 1:1515 HERITAGE DR STE 105
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-3378
Mailing Address - Country:US
Mailing Address - Phone:972-562-0190
Mailing Address - Fax:972-665-0076
Practice Address - Street 1:7300 ALMA DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-3565
Practice Address - Country:US
Practice Address - Phone:972-727-9133
Practice Address - Fax:972-727-9953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001011300Medicaid